Body Mass Index and Diabetes

Alert Reader and Industry Figure Stephen Newell pointed out the wonderfulness of “Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating”, by researcher Walter C. Willett, M.D.

It’s notable for being backed up by peer-reviewed studies, which is too rare in these kinds of books.
(“Whoa, Science? I’m suspicious!”)

As an example, the famous Nurses’ Health Study yielded the following horrible graph:

Grahp from Nurses' Health Study, showing dramatic, n-squared curve of BMI vs. diabetes risk.

Some of the risks, such as High Blood Pressure, have ‘only’ doubled by the time you’ve moved from a BMI of 20 to 24. But look at the way that Diabetes sails off the chart!

Woof, as a 6 foot 1/2 inch guy, I’d have to get down to about 165 pounds to have a BMI of 22. Seems like a lot of work. But then again, there’s the not-dying part…

OK, I’m in!

And remember: “It’s more fun to compete!

Fasting Blood Glucose Targets

There are (relatively) affordable kits available nowadays to test your blood glucose levels at home, and anyone who has fat around their waist or who has been told that they are insulin-resistant or pre-diabetic should buy one, and use it. But what do the levels mean? What’s good? What’s bad?

Somewhere around blood glucose levels as high as 300 mg/dL, they like to hospitalize you. That’s bad. What about lower levels?

One of the standard definitions of full-blown diabetes is a fasting blood glucose level (after nothing by mouth except water for eight hours) greater than 125 mg/dL, for two mornings running. This level was chosen because it is here that you start to see patients developing diabetic retinopathy, i.e. blindness. That’s bad, too.

So, you might argue that we should strive for levels lower than this, and indeed, everyone agrees that this is so. The old definition of pre-diabetes (where you have to start taking action) was a fasting blood glucose of 110 mg/dL or greater, but in 2003, this was lowered to 100 mg/dL, because people just kept, you know, dying.

But is 99 a low enough target? A study of several thousand high-risk patients (who had non-diabetic glucose levels, but had other risk factors for coronary heat disease, such as bad cholesterol or blood pressure) divided patients into five groups:

    100-125 (the ‘pre-diabetic’ group that we already know is bad)
    93-99 (the group that contains me)
    87-92 (people who are better than I am)
    80-86 (smug bastards)
    <= 79 (people who are pointlessly healthier than they need to be)

After factoring out increased risk due to Framingham risk score, BMI, fibrinogen, Lp(a), and homocysteine, the top three groups still had an increased risk of coronary heart disease, and investigators concluded that there is a “continuous relation between glucose level and [coronary heart disease] risk across the range of nondiabetic glucose levels, independent of traditional and nontraditional risk factors, and that this relationship is similar for men and women” (quoting the National Diabetes Education Initiative’s synopsis of the study).

Interestingly (again quoting the NDEI), “Adjustments for [coronary heart disease] related medications (e.g. aspirin, statins, etc.) did not diminish the relative risks ascribed to glucose.” (i.e. the other medicines didn’t keep sugar from killing you just as much).

Also, note that they didn’t find any benefit from being in the bottom group, as opposed to the next-higher group. Those guys really are healthier than they need to be!

Hoogwerf BJ, Sprecher DL, Pearce GL, et al. Blood Glucose Concentrations <=125 mg/dl and Coronary Heart Disease Risk. Am J Cardiol. 2002;89:596-599.

Your mileage may vary, but I’m going to be shooting for a fasting blood glucose of 86 or lower.

Hey, put down that jelly doughnut! (It’s like eating a cigarette!)

Losing Weight: Yo-Yo You

I came across these simple rules the other day in one of the nutrition books that I’ve been reading lately, which are a great synopsis of what we’ve been talking about:

1. If you try to lose weight by dieting, with no exercise, your body will lose fat and muscle.

2. If you go off your diet, still not exercising, then your body will gain fat, but no muscle.

There it is, a simple mechanism by which yo-yo dieting lowers your metabolic rate! There may be others, but we really only need one. Remember how your muscles consume many more calories than your fat does? After you’ve dropped weight by dieting without exercise, and put it back on by eating without exercise, you end up with less muscle, more fat, and a slower metabolism.

It’s why you not only rebound, but rebound to a wonderful new higher weight.

It’s not voodoo, though: if you spend some time exercising, it can all be fixed — you have a second chance.

I personally know several people who have lost a lot of weight, and kept it off for years (one of them for more than a decade, now), which virtually no one in this country ever does, and every single one of them, man and woman, say the exact same thing, when asked their secret: “I exercise.”

If you want to get it off, and keep it off, you’re going to have to exercise a little more.

25th Wedding Anniversary

Tom and Sylvia’s 25th Wedding Anniversary dinner at our favorite local Japanese restaurant, Tori Yen in Tujunga, California.

So that the photo would more properly mark the occasion, they gave Sylvia a geisha wig and a duck’s beak, and gave me a Groucho mask, along with authentic Japanese hair costumery.

They also festooned us with Lovely Parting Gifts — note the Umbrella Hat in foreground.

It’s a wonderful and peculiar place. We couldn’t have possibly enjoyed ourselves more.

Tom and Sylvia at Tori Yen, wearing a duck's beak and Groucho mask, as well as geisha wig and Japanese head scarf.